The Washington State Comparative Effectiveness Research Translation Network (CERTAIN) conducts patient- centered comparative effectiveness research (CER). Leveraging existing registries related to quality improvement at 55 of Washington State's 60 hospitals, CERTAIN developed automated tools for extraction of clinical data, created a state-of-the-art survey center to assess patient perspectives of healthcare and built the capacity, tools and administrative agreements across otherwise unrelated healthcare delivery systems to efficiently conduct statewide CER. The proposed infrastructure enhancements and expansion of stakeholder engagement activities will make CERTAIN more effective, target a broader range of advisor-prioritized questions and assure the network's sustainability. We propose the following specific aims: Aim 1: Enhance the CERTAIN infrastructure with a CERTAIN Hub that interfaces with patients in non-clinical and outpatient settings (using computers, mobile devices, tablets, paper) to assess Patient Reported Outcomes (PRO) and other patient perspectives of care. Aim 1a Pilot project: Assess the quality and completeness of data gathered from the CERTAIN Hub for patients undergoing spine surgery Aim 2: Expand the capability and sustainability of the CERTAIN network through more targeted engagement of the stakeholder community, advanced prioritization techniques and through the development of end-user oriented tools and products Aim 2a: Perform targeted stakeholder engagement activities using a novel, multi-dimensional research prioritization technique across areas of stakeholder interest (e.g. cancer care, spine, urology, vascular disease, diabetes management) Aim 2b: Develop a query tool for stakeholders to assess the capability and readiness of CERTAIN (both the network and the data repository) to address stakeholder-directed CER questions. Aim 2c: Incorporate CERTAIN Hub-derived data into customized, end-user reporting products and assess use and perceptions of value by clinicians, patients, delivery systems, and payers. Taken together, these infrastructure enhancements and stakeholder engagement activities will enable CERTAIN to be more effective and sustainable over time.